Where you are:
You are an FY2 in the A&E.Who the patient is:
Mr. Lincoln Peterson, a 60-year old gentleman presented with confusion.What you must do:
Take a focused history, assess his condition and manage him accordingly.
Monitor: O2 = Normal or low, BP = normal or low, H.R. = 120, RR 24, Temp 39.
History:
- Patient can answer questions with full sentences:
- Analyse shortness of breath.
- Ask about cough, fever, chest pain.
- Ask about regular medications, medical conditions and allergies.
ABCDE Assessment:
A - Airway
- Check for any obstruction.
- If SO2 Low: give oxygen via non-rebreather mask 100% oxygen 15L/min.
B - Breathing
- Examine the chest in order: Inspection, palpation, percussion, auscultation.
- Auscultation: unilateral coarse crackles.
- Order Chest X-ray and ABG. Lactate will be more than 2.
C - Circulation
- Check: pulse + CRT + BP + Insert 1 cannula.
- Request routine bloods, infection markers.
- Request ECG.
- If the blood pressure is low give 500ml of fluids over 15 minutes.
D - Disability
- Check: Blood Sugar + Temperature + Pupils.
- Temp 39: give paracetamol 1 g IV and start broad spectrum antibiotics.
- Request blood cultures.
- Re-assess blood pressure and if still low give additional 500ml of fluids over 15 minutes up to 2L in the 1st hour
E - Exposure
- Examine the abdomen, legs and private area.
- Insert a catheter and take urine culture.
- Start your discussion with the patient.
Handover
- SBAR approach
- Discuss management in 2 minutes with the examiner
Situation
- I am Dr (—). I managed a 60-year-old male patient, Lincon Peterson, who presented to A&E with confusion.
Background:
- Jack had a shortness of breath and confusion. He has been coughing for 3 days.
- He has no known allergies.
Assessment
- On initial assessment, his vital signs were unstable and the temperature was high. So, I suspected sepsis and followed the sepsis six pathway. I gave him 100%O2 at 15L via a non-rebreather mask. I then administered IV fluid 500 ml and IV broad spectrum antibiotics. I took blood from him for blood culture and other routine investigations. I performed ABG to check blood gas and lactate. I inserted a catheter to measure the urine output. I gave him IV paracetamol 1g for his fever.
Recommendation
- After the initial treatment, his vitals improved. Now, his vitals are (------). My recommendation is to admit this patient to the ICU. In the meantime, I’d like to continue monitoring his vital signs and response to the treatment closely. I would like to change antibiotics according to his C&S result.